Sunday, July 6, 2008

Take The Oxygen First, pt. two

If this is first time you are looking at my blog, please go back and start with the first half of this article.

These stubborn caregivers have made up their mind, sometimes decades earlier, and they are not about to listen to anything that challenges their preconceived notions...

But there are some very good reasons for being open-minded about assisted living. For example there comes a time, especially with Alzheimer’s disease, that the care needs of the sufferer are greater than the caregiver’s ability to provide for them. Given this circumstance, it would be a terrible disservice to the loved one, to keep them at home with inadequate care.

Unfortunately, when their care needs are this advanced, the only placement option is going to be a nursing home. The care required at that stage are medical not custodial, and therefore surpass the services offered by assisted living or board and care.

I want to propose a better course of action. If the caregiver relents, and a placement is made into an assisted living, they now have a home-like environment that will be safe, comfortable, and friendly towards the disabled family member. The caregiver is still able to oversee their loved one’s care. And as I will explain in a moment, the impaired family member can age in place and the assisted living will continue to provide care as demands increase, even end-of-life care.

The difference is this – an assisted living will accept a client that meets their resident profile, and when they do they generally make an unwritten commitment to their families. They will always provide the necessary care, and they will monitor the resident’s decline and keep the family and the doctors properly informed.

Generally the first level of care in assisted living is bathing assistance, medication management, and personal laundry. Nevertheless, as more care is need they will provide care and supervision, incontinence care, wheelchair transfers and escorts. The care in Assisted Living can increase to keep pace with the resident's decline. And when the end of life is approaching they can introduce the family to hospice, which in turn can provide the maximum amount of comfort measures to insure a peaceful passing.

So, if you approach board and care or assisted living while your loved one fairly high functioning, chances are they will keep your parent or spouse no matter how much they decline, thus permanently avoided a nursing home placement. Saddly, if you wait too long, no assisted living will touch them. Not so much because they don’t want to, but because the State regulations that govern them have strict admission criteria. The State wants to insure that board and cares and assisted living communities do not take high accuity that belong in a nursing home. However, once a client is admitted to assisted living, the same State regulations protect the resident’s ability to remain in the facility, thus aging in place.

To summerize, we now have a strong argument in favor of placement for your loved one, and preferably sooner than later.

Granted no employee of an assisted living knows or loves your parent or spouse the way you do, and no one understands them or their needs the way you do. There is not a person or facility that can replace you. So it behooves you and your loved one that you take proper care of yourself, so that you are around for the rest of their life. But as I described in part one of this article, I have seen many a late-stage Alzheimer's patient with no family, per se, to oversee thier care, because the primary caregiver has passed away themselves.

So let this be one more reason for considering assisted living: There is only one of you. You prepare and provide meals, you ensure a safe and secure home, you provide transportation, you are the eyes and the ears for the doctor, and you provide medication management. You also provide socialization and human contact and interaction. You make sure they have emotional stability, and feel loved. You provide entertainment. You do the laundry and make sure they bathe. You see to their grooming and you make sure they are dressed appropriately. You are burning yourself out.

However, if you were to place your loved one in a nice assisted living community, all these activities of daily living will be handled by their staff. This in turn frees you up to not only spend time on yourself, but to also spend quality time with your parent or spouse. Again, I suggest you take the oxygen first. If you do that your health will improve, you will extend your life, and you will always be there to care and advocate for your loved one.


  1. I find myself at the level you speak of in your article. My Mom has been in assisted living for 1.5 years now. I am the only family caregiver locally (two siblings live in other states) but I seem to be having a delayed reaction to my newly aquired caregiving. Can I ask, why? Is this normal? Do you have any insight on this particular situation?

  2. Katelyn MontgomeryJuly 15, 2008 at 6:07 AM

    Dear Dr. Vanderhider,

    I'd like to share a new resource with you and your readers, for anyone caring for a loved one with Alzheimer's disease in their home.

    The Copper Ridge Institute, affiliated with The Johns Hopkins University, is a leading provider of dementia research, care and education. The Institute has developed the first training resource of its kind for caregivers, providing a step-by-step method for caring for loved ones with Alzheimer’s disease. Available as a DVD and webcast, the FREE program ( recreates many of the daily situations that caregivers may encounter and provides coaching for each of these activities based on best practices developed by The Copper Ridge Institute.

    In the arena of Alzheimer's disease the overwhelming emphasis has been on finding the cure. Little emphasis has been placed on researching effective care and teaching best practices for persons with memory impairment. The Copper Ridge Institute has taken a leadership role in the care arena. Fourteen years of clinical work and collaboration has enabled The Copper Ridge Institute to establish a program of care and treatment that brings dignity and a quality of life to those persons and families struggling with Alzheimer's disease. Caring for a Loved One with Alzheimer’s Disease is a breakthrough program that will help many of us faced with the daunting and emotionally charged task of caring for those we love with dementia.

    We’d like to ensure that as many people as possible can take advantage of this free program so are reaching out to blogs like yours to help us make people aware of the program. Could you please let your readers know about this important resource?

    Many thanks,
    Katelyn Montgomery
    on behalf of The Copper Ridge Institute

  3. This is wonderful information, and well worth passing on. Simply go to
    I especially liked that every video clip was also in spanish.
    The information is superb, and the quality is excellent.
    This is a wonderful resource for all caregivers.

  4. Dear anonymous. Can you tell me more about your feelings? I am intrigued by your comment that you are having a delayed reaction. What kind of reaction?


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